Gestational Diabetes Mellitus, Placental Histomorphometry, and Cardiovascular Disease Risk: Does Race/Ethnicity Matter?

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 806-823-Gestational Diabetes
Basic/Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-811
Deanna Dawson*1, Julia Wenger2, Ravi Thadhani2, Drucilla J Roberts2 and Rhonda Bentley-Lewis2
1University of California, Santa Cruz, Santa Cruz, CA, 2Massachusetts General Hospital, Boston, MA
Title: Gestational Diabetes Mellitus, Placental Histomorphometry, and Cardiovascular Disease Risk: Does Race/Ethnicity Matter?

Deanna Dawson, Julia Wenger, Ravi Thadhani, Drucilla J. Roberts,* Rhonda Bentley-Lewis

Background: The human placenta is the critical organ responsible for the transfer of blood, nutrients, oxygen, and waste between the mother and fetus. Because the placenta shares the metabolic milieu of both mother and fetus, maternal disease can manifest in placental pathology. However, implications for maternal cardiovascular disease (CVD) risk subsequent to placental pathology have not been elucidated.

Objective: To investigate the association of specific placental pathology in women with gestational diabetes mellitus (GDM) with subsequent maternal CVD risk and to determine if race/ethnicity modifies these associations.

Methods: Study participants were selected from the MGH pathology archives between January 1, 2001 and December 31, 2009 using search terms “placenta,” “gestational diabetes,” and “GDM”. From the initial 765 placental specimens identified, we selected 129 placenta from singleton, full-term, live births whose mothers had Carpenter-Coustan-defined GDM and complete clinical/demographic data. Race/ethnicity was self-reported. CVD risk outcomes included essential hypertension and type 2 diabetes (T2D). Placental diagnoses scored included villous maturation, fetal and maternal inflammation, villous edema, and chorangiosis. Placental pathology was re-reviewed by co-authors DJR and DD blinded to race/ethnicity and prior pathologic diagnoses.

Results:  Of the 129 women, 48 were white, 51 were Hispanic, 14 were Asian, 4 were black, and 14 were classified as other/unknown (excluded from analysis). The women were followed for a median of 4.1 (range 0.0-8.9) years from delivery to CVD risk outcome. Because of the limited number of non-Hispanic minority women, we aggregated the women into white and non-white groups. The non-white women had lower first prenatal visit systolic blood pressure (108 ± 10 vs. 116 ± 13 mmHg; p = 0.0004); were less likely to self-identify as a past or current smoker (8.7 vs. 35.4%; p =0.003); but were more likely to develop T2D (34.8 vs. 12.5%; p = 0.01) than the white women. Regarding placental pathology, the only significant difference was that non-white women had less chorangiosis than did white women (52.1 vs. 31.9%; p = 0.03).

Conclusion: Although more non-white women developed T2D, more white women had chorangiosis. This inconsistency may have been due to the greater percentage of past/current smokers among white compared to non-white women; however, the degree of insulin use during pregnancy warrants consideration. Further study is necessary to investigate the relationship between chorangiosis and future maternal CVD risk and race.

 

Nothing to Disclose: DD, JW, RT, DJR, RB

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: Sources of Support: Harvard Catalyst Summer Clinical and Translational Research Program (DD); MGH Pathology Department support (DJR); K24 DK094872 (RT); and NIH 1K23RR023333 and the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program (RB-L).